FORMS

2018 Annual Physical Form (PCP)
Allstate – Online Policy Access and Electronic Claim Filing
Allstate Wellness Claim Form (Critical Illness & Cancer Policies)
Allstate Accident Plan Office Visit Claim Form
Allstate Accident Claim Form
Allstate Cancer Policy Claim Form
Allstate Critical Illness Policy Claim Form
Health Savings Account Application
EyeMed Out-of-Network Claim Form
Flexible Spending Direct Deposit Form
Flexible Spending Reimbursement Request Form
Flexible Spending Debit Card Substantiation Form
Flexible Spending Qualifying Events Form
Life Insurance Evidence of Insurability Form (EOI)
Life Insurance Portability Form
Life Insurance Conversion Form
Rx Claim Form – OptumRx
Symetra Long Term Disability Claim Form (Employees w/less than 5 yrs)
Voluntary Short Term & Long Term Disability Insurance Claim Form
Voluntary Short Term & Long Term Disability Cancellation Form